CONFIDENTIALITY AND PRIVACY PRACTICES
Contents of all therapy sessions are considered to be confidential. Both verbal information and written records about a client cannot be shared with another party without the written consent of the client or the client’s legal guardian. Noted exceptions are as follows: Duty to Warn and Protect When a client discloses intentions or a plan to harm another person, the mental health professional is required to warn the intended victim and report this information to legal authorities. In cases in which the client discloses or implies a plan for suicide, the health care professional is required to notify legal authorities and make reasonable attempts to notify the family of the client. Abuse of Children and Vulnerable Adults If a client states or suggests that he or she is abusing a child (or vulnerable adult) or has recently abused a child (or vulnerable adult), or a child (or vulnerable adult) is in danger of abuse, the mental health professional is required to report this information to the appropriate social service and/or legal authorities. Children and Adolescents When working with children and adolescents it is essential that the child or adolescent be able to trust his/her therapist. In that regard, it is appropriate to keep the confidentiality of a child the same way we keep the confidentiality of an adult. However, as a parent or guardian you have the right to question and understand the nature of our activities and the progress of your child. In general, we will not release specific information that the child provides, however it is always appropriate to discuss your child’s progress and participation in treatment. Insurance Providers Insurance companies and other third-party payers are given information that they request regarding services to clients. Information that may be requested includes, but is not limited to: types of service, dates/times of service, diagnosis, treatment plan, description of impairment, progress of therapy, case notes, and summaries. Court Cases In most legal proceedings, you have the right to prevent your therapist from providing any information about your treatment. In some cases involving child custody and in those in which your emotional condition is an important issue, a judge may order your therapists’ testimony if he/she determines that the issues demand it.
POLICIES AND PROCEDURES
This information about the office of Michele Sallean has been compiled to provide answers to questions about appointments, messages, emergencies, insurance, and confidentiality. Please review it carefully. If you have any questions or concerns, feel free to discuss them with me. At the initial appointment you will be asked to sign an “Agreement of Services” which will become a part of your file.
APPOINTMENTS Appointments can be scheduled online (www.michelesallean.com), by email (firstname.lastname@example.org), or by calling the office (919-415-0454). It is very important that once the frequency and duration for therapy is discussed, that you are able to make and maintain that commitment. Please be aware that each return appointment is reserved specifically for you. If a cancellation is necessary, 24 hours notice is required. If 24 hours notice is not given there will be a “no show” charge of $40. After 3 charges to your account, Michele Sallean reserves the right to terminate this working relationship.
MESSAGES During business hours, Michele Sallean may not be immediately available to answer your calls. However, every attempt will be made to return your calls as soon as possible. Emails will be answered on the same day they are received.
INSURANCE Payment is required at the time of your appointment. Most insurers will reimburse you in full or in part by filing a member claim. This one page form will be completed by us and provided to you at each visit. Michele Sallean is an out of network provider and coverage benefits will vary with each health plan. Please contact your healthcare insurer for details on your individual plan.
EMERGENCIES If you have an emergency please dial 911 or visit your local emergency room immediately. Upon arriving, please give the emergency personnel Michele Sallean’s name and contact information.
This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully. Your Rights You have the right to:
• Get a copy of your paper or electronic medical record
• Correct your paper or electronic medical record
• Request confidential communication
• Ask us to limit the information we share
• Get a list of those with whom we’ve shared your information
• Get a copy of this privacy notice
• Choose someone to act for you
• File a complaint if you believe your privacy rights have been violated
You have some choices in the way that we use and share information as we:
• Tell family and friends about your condition
• Provide disaster relief
• Include you in a hospital directory
• Provide mental health care
• Market our services and sell your information
• Raise funds
Our Uses and Disclosures
We may use and share your information as we:
• Treat you
• Run our organization
• Bill for your services
• Help with public health and safety issues
• Do research
• Comply with the law
• Respond to organ and tissue donation requests
• Work with a medical examiner or funeral director
• Address workers’ compensation, law enforcement, and other government requests
• Respond to lawsuits and legal actions
For additional information, please contact your therapist or visit: http://www.hhs.gov/ocr/privacy/hipaa/npp_booklet_hc_provider.pdf